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Cheyne-Stokes respiration is also known as periodic respiration, with cycles of respiration that are increasingly deeper then shallower with possible periods of apnoea. Although 50% of patients with moderate-to-severe congestive heart failure are affected by significant Cheyne-Stokes respiration, its exact pathophysiology remains unclear.Typically, over a period of one minute, a 10- to 20-second episode of apnoea or hypopnoea occurs followed by respirations of increasing depth and frequency. The cycle then repeats itself.
- Patients with Cheyne-Stokes respiration usually present with the symptoms of orthopnoea, paroxysmal nocturnal dyspnoea, excessive daytime sleepiness and witnessed apnoeas in the setting of congestive heart failure.
- Cheyne-Stokes respiration is a poor prognostic sign, most often seen in terminal care. However, it may also be present as a normal finding in children, in healthy adults following fast ascending to great altitudes, or in sleep.
- Causes include:
- Brainstem lesions: cerebrovascular event.
- Raised intracranial pressure.
- Heart failure.
- Chronic pulmonary oedema.
- Altitude sickness.
- Management includes medical therapy directed at congestive heart failure, continuous positive airway pressure (CPAP) and/or supplemental oxygen.
Paroxysmal nocturnal dyspnoea
- Acute dyspnoea causing the patient to awake from sleep and then sit upright or stand out of bed for relief.
- Associated with pulmonary oedema due to left ventricular failure (eg, due to mitral stenosis, aortic insufficiency or hypertension) but nocturnal attacks of bronchial asthma may be difficult to differentiate.
- Paroxysmal nocturnal dyspnoea results from increased left ventricular filling pressures due to nocturnal fluid redistribution and enhanced renal reabsorption and therefore has a greater sensitivity and predictive value than dyspnoea.
This breathing is deep sighing respiration associated with metabolic acidosis - eg, diabetic ketoacidosis, chronic kidney disease.
- Acute dyspnoea occurring in terminal stages of exsanguinating haemorrhage.
- It is a grave sign and indicates the need for immediate transfusion.
Hyperventilation may cause abnormally low levels of carbon dioxide in the blood and lead to dizziness, light-headedness, weakness, unsteadiness, muscle spasms in the hands and feet, and tingling around the mouth and fingertips. Causes include:
- Head injury.
- Cerebrovascular event (pontine lesions); breathing is noisy.
- Inappropriate use of stimulant drugs; excessive intake of aspirin.
- Hypoventilation is breathing that is not adequate to meet the needs of the body (too shallow or too slow).
- Hypoventilation causes an increase in blood carbon dioxide level and a decrease in oxygen level.
- Causes include:
- Central nervous system - eg, drugs (central nervous system depressants), cerebrovascular events, trauma, neoplasms.
- Obstructive sleep apnoea.
- Severe chest wall deformities - eg, kyphoscoliosis.
- Neuromuscular diseases - eg, myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, muscular dystrophy.
- Severe chronic obstructive pulmonary disease.
- Congenital Central Hypoventilation Syndrome is a rare cause of hypoventilation in children and is present from birth.
Obstructive sleep apnoea
- Obstructive sleep apnoea is caused by intermittent and repeated upper airway collapse during sleep.
- This results in irregular breathing at night, and excessive sleepiness during the day.
Further reading and references
Ingbir M, Freimark D, Motro M, et al; The incidence, pathophysiology, treatment and prognosis of Cheyne-Stokes breathing disorder in patients with congestive heart failure. Herz. 2002 Mar27(2):107-12.
Cherniack NS, Longobardo G, Evangelista CJ; Causes of Cheyne-Stokes respiration. Neurocrit Care. 20053(3):271-9.
AlDabal L, BaHammam AS; Cheyne-stokes respiration in patients with heart failure. Lung. 2010 Jan-Feb188(1):5-14. doi: 10.1007/s00408-009-9200-4. Epub 2009 Dec 3.
Momomura S; Treatment of Cheyne-Stokes respiration-central sleep apnea in patients with heart failure. J Cardiol. 2012 Mar59(2):110-6. doi: 10.1016/j.jjcc.2011.12.008.
Chen ML, Keens TG; Congenital central hypoventilation syndrome: not just another rare disorder. Paediatr Respir Rev. 2004 Sep5(3):182-9.
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